The URL can be used to link to this page

Home My WebLink AboutBLDP-21-003830 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/11/21 PERMIT# BLDP-21-003830 1 li S ''�� JOBSITE ADDRESS 99 EILEEN ST OWNER'S NAME HARRINGTON DOROTHY EST OF P OWNER ADDRESS CIO TAPPEN JEANNE 15 DLIKAS BROOK RD PLYMPTON,MA 02367 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT _CLEARLY NEW: ❑ RENOVATION:E REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL 1 _ SERVICE/MOP SINK TOILET 2 URINAL _ WASHING MACHINE CONNECTION 1 ` WATER HEATER WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO E IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY E BOND❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Timothy Harder LICENSE 1 311 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# - LLC ❑# COMPANY NAME TIMOTHY P HARDER ADDRESS 32 Siasconset Dr CITY ISagamore Beach STATE MA ZIP 025622724 TEL FAX 7 CELL ] EMAIL r� g ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes dk !'Lj21 S ❑I] No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES S PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK +4'= .N\ L QO r MA DATE /.2/3I �"% PERMIT# 6thb l? /-OD 3F JOBSITE ADDRESS 1.1ci E., t,„ c r' S-'s-. OWNER'S NAME ►R-eic-s - —10 cQ P OWNER ADDRESS c. TEL Z I 70 t' rAI-FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL II PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:4_ PLANS SUBMITTED: YES❑ NO 0 FIXTURES 1 FLOOR—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB \ ' CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM - DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER l . - DRINKING FOUNTAIN . FOOD DISPOSER FLOOR/AREA DRAIN , INTERCEPTOR(INTERIOR) - - KITCHEN SINK l -- LAVATORY 1 ROOF DRAIN SHOWER STALL I - SERVICE/MOP SINK TOILET .� URINAL I�.. WASHING MACHINE CONNECTION i, r E t �b.._.. 1 WATER HEATER ALL TYPES WATER PIPING OTHER JAN i D.; BUILDING DmpeR MC VT I by. +`____ INSURANCE COVERACOVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch,142. YESit NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABILITY INSURANCE POUCY A OTHER TYPE OF INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accu a to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ail Pertinent provision of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _) Pi�/ ,&_. PLUMBER'S NAME LICENSE# t 53 I \ SIGNATURE �r MP ft JP❑ CORPORATION 0# PARTNERSHIP❑# LLC 0# COMPANY NAME \3vc-.c&Q r \V,,„,.x_VD,A) ADDRESS ?> � aSc:v r S-e It S)t' CITY SASa r..,e t sr c c./— STATE w' ZIP 0'3Slc TEL FAX CELL- 20 -7c)( /yY� EMAIL hGta - (uri.U;/L, ( 4L'I . Carte 130